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Carolyn Johnson, Rph. Computer Support Team Director Warm Springs Health & Wellness Center

IHS EHR. Indian Health Service Electronic Health Record. Carolyn Johnson, Rph. Computer Support Team Director Warm Springs Health & Wellness Center. Objectives. Implementation Impact on Process Cost Estimates Impact-Outcome Data. Implementation. Confirmed Leadership support

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Carolyn Johnson, Rph. Computer Support Team Director Warm Springs Health & Wellness Center

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  1. IHS EHR Indian Health Service Electronic Health Record Carolyn Johnson, Rph. Computer Support Team Director Warm Springs Health & Wellness Center

  2. Objectives • Implementation • Impact on Process • Cost Estimates • Impact-Outcome Data

  3. Implementation

  4. Confirmed Leadership support Tribal Endorsement Area Office Support Patient Awareness Clinician driven Implementation-Commitment

  5. Implementation-Staffing • Provider support during implementation • Staff shift from Medical Records to other departments : • 2 Medical Records are in PCC part time • 1 Med rec tech is a nurses aid • 1 Med rec tech is a Benefits Coordinator • More nurses aids after EHR

  6. Staffing-Clinical Applications Coordinator Duties • Works cooperatively with Site Manager • Coordinates Implementation • EHR User Support • Training • Customize Software • Workflow

  7. Implementation-Software • Package upgrades to RPMS • Cache • Scheduling (PIMS) • Radiology • Text Integration Utility • Pharmacy Inpt Suite • Adverse Reaction Tracking • Pharmacy 7 • Numerous RPMS patches

  8. Implementation-Hardware/Infrastructure upgrade • RPMS server • Training server • Network • Wireless network • Lab Interface Upgrade • Workstation Access-Everywhere • Backup Power

  9. Implementation Team Members • Clinical Champions from each discipline (lab,rn, rph,md,,etc) • Administration/Executive Leadership • Information Technology • Include Area IRM representation • Clinical Application Coordinator

  10. Implementation Team Roles • Identify and define Policies and Procedures • Address staffing and scheduling during transition • Peer Training & Marketing • Monitor and Execute Implementation Plan • Design and Approve templates, menus, and ordering lists for E.H.R.

  11. Project Plan

  12. Implementation Strategy Implementation-Who and When • Everyone at once • Lab ordering , then radiology ordering, then pharmacy ordering, then notes • Bring up one team/dept at a time

  13. Implementation Sample Schedule

  14. Implementation- Configuration • Design templates • Design Menus and Quick Orders • Meds, Labs, Rad, Nursing • Define consults • Pick lists and Superbills • Note Titles • User Setup (keys) • Parameters • Printing Chart Copy and Orders • Print Formats

  15. EHR beforeConfiguration

  16. EHR after Configuration

  17. Implementation-Setting up Orders

  18. Implementation-Setting up templates

  19. Implementation-Training/Marketing • Staff Training: • EHR Demo Movie Presented in General Staff Meeting • Pharmacy Training Module: • Available on Warm Springs Web Site • Mandatory for all pharmacy staff • CPRS Training Module: • Presented at Staff Meeting • Interactive training posted on Warm Springs Web Site • Mandatory for providers • National Programs Web Demo for our clinic

  20. Pre-Implementation Training • 2 hour training for everyone on VIEWING patient data in E.H.R. • EHR Test System Loaded On All User’s Computers • Newsletters, Web Updates, Meeting Updates

  21. ImplementationTraining – Go Live Week • 4-6 hours training outside of clinic • Departmental Trainings • Use Knowledgeable Trainers • One-On-One Training Also • Competency Checklists

  22. Going Live • Intense CAC and IT Support • Make Appropriate Scheduling Adjustments • Daily Debriefings…. • Procedural Questions • Technical Issues • Training

  23. Impact on Process

  24. Issues – General • Automation supports well-designed business processes, but makes poorly-designed processes worse. • EHR will shine a light on the cobwebs • Facilities need to be willing to change to maximize the positive impacts of EHR • Don’t design workarounds so that you can do things the way you used to . . . DON’T AUTOMATE WASTE!

  25. Medical Records Process • When to stop pulling the chart • Filing notes AND orders in chart? • Print And File Chart Copies? Batch Print? • Release Of Information? • Outside Consults? Scanning? • Incorrect Entries? • Entering newborns into RPMS asap

  26. Miscellaneous Policies/Procedures • People who aren’t using E.H.R. yet- how are they handled? • Use of personal templates • Template approval process • Flowsheets and other paper documents

  27. Radiology Process Changes • Using RPMS Radiology Package • Providers order the exam electronically • Radiology orders print out automatically

  28. Lab Process/Prep • All Labs need to be entered in RPMS • On-site Labs • Reference Labs • Computer Access Points • Changing from Esig to EHR • Created Quick Order Menus

  29. Lab Process • How to handle add on labs • How does the lab know when the pt is there? • Lab only visits • How to communicate the “Signs and Symptoms” (lab pov) to the lab

  30. Lab Quick Orders

  31. Pharmacy Process • Outside Prescription Orders • Printing pharmacy service copies for orders • Refill and New prescriptions aren’t always grouped • Printing controlled substances • How to incorporate pharmacy patient signature log • Pharmacy Requirement for Completed/Signed Notes

  32. PCC Coding Process • Coding and Data entry is combined position at our facility • Coders are assigned to provider teams • Coding/Auditing from daily reports (VGEN and Audit Report) • We code from EHR, not the chart • Corrections are communicated to provider via notification

  33. PCC Error Report • Instead of 2 data entry clerks, we have 70 data entry providers who encode data • Daily Error Reports should be run • Most Common Errors: • Missing POV • Missing E&M Code • .9999 - Uncoded diagnosis • Duplicate Visits • 2 visits created on the same day – have to be merged • Dental makes 2 visits that need to be merged • Patch coming

  34. PCC-Business Office Communications • Bills are generated before PCC has reviewed the visit

  35. What does EHR cost?

  36. Cost Estimates-WSP

  37. Impact

  38. GPRA Indicators - Flu Vax

  39. GPRA Indicators – Pneumovax over 65 y/o

  40. GPRA Indicators – Tobacco Use Assessment

  41. GPRA Indicators – DV/IPV

  42. GPRA Indicator – BMI 2-74 y/o

  43. GPRA Indicators – Med Ed

  44. Revenue • Increased 56% 2005 compared to 2004 • More specific coding • Clinic Efficiency • Will improve with PCC patch to correct visit creation errors

  45. What’s Next? • Scheduling GUI • Vista Imaging • Dental COTS Package • Digital Radiology • Voice/Stylus Data Entry

  46. Questions?

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